Aim. To study the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with cardiovascular risk factors (RFs).

Material and methods. The database from the ESSE-RF2 and ESSE-RF3 epidemiological studies was used, including data from surveys of population aged 35-64 years in 18 Russian regions (n=21204). To assess the prevalence of NAFLD, the fatty liver index (FLI) was used. Statistical analysis was performed using the statistical programming language and the R environment (version 3.6.1) with open-source code. The significance level for all tested hypotheses was p≤0,05.

Results. Standardized prevalence rates of FLI ≥60 in the ESSE-RF3 study are slightly higher than in the ESSE-RF2 study (39,2% vs 42,3%, respectively). Multivariate analysis adjusted for sex, age, region, settlement type, and education showed significant associations of FLI ≥60 with hypertension, type 2 diabetes, hyperuricemia, lipid metabolism disorders, elevated high-sensitivity C-reactive protein levels, and cerebrovascular accident in men and women.

Conclusion. Multivariate analysis confirmed the closest association of NAFLD with hypertension, type 2 diabetes mellitus, metabolic disorders, nonspecific inflammation, dyslipidemia, and cerebrovascular accident in men and women.

Aim. To identify associations between cardiovascular risk factors, cardiac remodeling and paroxysmal atrial fibrillation (AF) in patients with hypertension (HTN).

Material and methods. A total of 120 patients with grade I and II HTN were examined. They were divided into two groups as follows: the study group (n=60) — paroxysmal AF; comparison group (n=60) — without AF. All patients underwent anthropometric measurements, assessment of the main risk cardiovascular factors, blood lipid profile, uric acid and creatinine levels, and transthoracic echocardiography.

Results. The following markers of paroxysmal AF in hypertensive patients were determined: high-density lipoprotein cholesterol level ≤1,5 mmol/l, indexing left atrial (LA) volume by height (>18,5 ml/m² in men and >16,5 ml/m² in women), indexing LA volume by body surface area (>34 ml/m² for both sexes), left ventricular end-diastolic dimension/height index ≥2,89 cm/m, peak late diastolic filling transmitral velocity ≤0,78 m/s.

Conclusion. A decrease in high-density lipoprotein cholesterol and peak late diastolic filling transmitral velocity, LA dilation, and an increase in the left ventricular end-diastolic dimension/height index are associated with paroxysmal AF in patients with hypertension and can be further included in the related risk stratification.

Aim. To assess the relationship between right atrial (RA) dilation and paroxysmal atrial fibrillation (AF) in patients with hypertension (HTN) and chronic obstructive pulmonary disease (COPD).

Material and methods. This retrospective cross-sectional study included 369 patients with HTN and COPD, who were divided into 2 following groups: group I — 68 (18,42%) hypertensive patients with COPD and paroxysmal AF; group II (comparison group) — 301 (81,57%) patients with HTN and COPD without arrhythmia.

Results. Patients in group I had significantly higher RA area and left atrial (LA) volume index (LAVI) than patients in group II. Multivariate regression analysis revealed that the RA area and LAVI were associated with paroxysmal AF in comorbid patients with HTN and COPD. To assess the relationship between atrial size and paroxysmal AF in patients with HTN and COPD, we developed a mathematical model with the following equation: р=1/(1+e^-z)*100%, z=-12,51+0,130*LAVI+0,408*RAA, where p is the probability of having paroxysmal AF (%), RAA — RA area (cm²); LAVI — left atrial volume index (ml/m²). The p-value ≥24% indicates a high probability of paroxysmal AF (area under the ROC curve (AUC) =0,89, sensitivity — 80%, specificity — 77%).

Conclusion. RA dilation is associated with paroxysmal AF in patients with HTN and COPD — odds ratio (OR) 1,50; 95% confidence interval: 1,27-1,79.

Aim. To evaluate the effectiveness of the rehabilitation program for palliative care patients with heart failure (HF) with body composition disorders.

Material and methods. The study involved 298 patients (115 men and 183 women; mean age 61 years) with diagnosed HF and indications for palliative care. The patients were divided into clinical clusters using the сhi-square automatic interaction detection. The 1^st clinical cluster included patients with sarcopenic obesity (n=69 [23,2%]), the 3^rd cluster — patients with cardiac cachexia (n=47 [15,8%]), the 2^nd cluster occupies an intermediate position with an isolated disorder of body composition as follows: sarcopenia or obesity, or without these disorders (n=182 [61,1%]). Then, 2 groups (main and control) of 20 people each were formed from each cluster. The main groups of patients underwent a 6-month rehabilitation program with treatment corresponding to the clinical guidelines of the Ministry of Health of the Russian Federation for HF. The control groups of patients underwent only pharmacotherapy.

Results. Patients from all control groups had a significant decrease in muscle mass, while in the 1^st and 2^nd clusters there was an increase in body mass, and in the 3^rd cluster — a decrease. The quality of life of patients from the control groups significantly decreased. Patients from the main groups of the 1^st and 2^nd clusters had a significant increase in muscle mass and a decrease in body weight. In patients of the 3^rd cluster, body weight continued to decrease, but muscle mass indices remained stable. The quality of life of patients from the 1^st cluster improved in all indices, and in the 2^nd cluster — in scale 2. In patients of the 3^rd cluster, the quality of life worsened.

Conclusion. The rehabilitation program including exercise and a high-protein diet improved the muscle characteristics and the quality of life of palliative patients with HF. At the same time, the greatest effectiveness of the method was demonstrated in patients with sarcopenic obesity (1^st clinical cluster), and the least — in patients with cardiac cachexia (3^rd clinical cluster).

Aim. To study the relationship between epicardial/visceral obesity and cardiac remodeling characteristics in patients with acquired mitral valve (MV) disease and indications for surgical treatment of the defect.

Material and methods. The study included 49 patients hospitalized for surgery of non-infectious acquired MV defect. Patients were divided into groups according to computed tomography as follows: group 1 — with visceral obesity (visceral adipose tissue ≥130 cm² (n=28)), and group 2 — without visceral obesity (n=21).

Results. Patients with visceral obesity had more impaired left ventricular (LV) global longitudinal strain compared to the group without visceral obesity (-15,65 [-18,8; -11,6] vs -19,4 [-21,3; -16,9]%, p=0,020). Right ventricular ejection fraction (3D echocardiography) in group 1 was lower compared to patients in group 2 as follows: median 46 [40,6; 48,9] vs 53 [45,8; 54,2]% (p=0,042). Increase in epicardial adipose tissue (EAT) volume by 1 cm³ according to multislice computed tomography was associated with left atrial increase by a B-coefficient of 0,009 (p=0,001) and LV end-systolic volume by a B-coefficient of 0,1224 (p=0,046). The visceral adipose tissue/subcutaneous adipose tissue index >0,4 is associated with an increase in the LV mass index by a B-coefficient of 44,7 (p=0,001). According to the ROC analysis, the EAT volume >115,1 cm³ is associated with arrhythmias such as atrial fibrillation (AUC=0,714 (p=0,003)).

Conclusion. Visceral obesity is associated with a more pronounced structural and functional impairment of heart ventricles, while EAT volume >115,1 cm³ — with atrial fibrillation before MV defect surgery.

Aim. To evaluate the results of coronary intravascular ultrasound (IVUS) in elderly and senile patients in various clinical situations.

Materials and methods. The study included 155 patients aged >60 years, 118 of whom underwent elective percutaneous coronary interventions (PCI), and 37 patients were emergently hospitalized for non-ST-elevation myocardial infarction (NSTEMI). The group of elective PCI was divided into 2 following subgroups: the study group (n=58) — IVUS-guided coronary stenting, and the control group (n=60) — angiography-guided PCI. Stenting was performed based on previously performed diagnostic coronary angiography (CAG). Remote treatment results were assessed over 5 years. All patients of the NSTEMI group after diagnostic CAG underwent preoperative IVUS. We assessed the reasons for IVUS, the rate of management changes based on IVUS data, as well as immediate outcomes after endovascular treatment.

Results. The most frequent adverse event after elective PCI in patients of older age groups was repeat revascularization in the target vessel system, the risk of which was maximum by 3 years of follow-up and decreased by 5 years (odds ratio (OR) 5,09 after 1 year, OR 9,32 after 3 years and OR 5,62 after 5 years). Similar changes were revealed for the total number of cardiovascular events (OR 1,9 after 1 year, OR 3,1 after 3 years and OR 2,4 after 5 years), the risks of acute myocardial infarction (OR 2,0 after 1 year, OR 4,07 after 3 years and OR 2,1 after 5 years) and stent restenosis (OR 3,0 after 1 year, OR 7,12 after 3 years and OR 5,62 after 5 years). No differences in total mortality were found in the study and control subgroups of elective interventions (OR 0,98 after 1 year, OR 1,47 after 3 years, and OR 1,27 after 5 years, p>0,05). In older patients with NSTEMI, IVUS influenced the management strategy changes in 81% of cases, while in 5,4% of cases its use resulted in refusal of PCI, and in 70,3%, infarction-related lesions were confirmed according to IVUS data. In addition, IVUS in the treatment of patients with NSTEMI demonstrated significant differences in the angiographic and IVUS characteristics of vessel diameters (2,95±0,53 vs 3,6±0,56 mm, p=0,034) and the rate of incomplete stent apposition (11,1 vs 88,9%, p=0,002).

Conclusion. The use of IVUS in myocardial revascularization in elderly and senile patients in various clinical situations significantly reduces the rate of long-term recurrent cardiovascular events, and also affects the management strategy and immediate outcomes of stenting.

Aim. To study the potential of volume sphygmography (VS) with assessment of arterial stiffness (AS) as an alternative to carotid ultrasound in cardiovascular risk (CVR) stratification in a Tomsk adult population sample.

Material and methods. The results of a survey of a Tomsk population sample aged 40 to 64 years (n=971) were analyzed. They underwent carotid ultrasound and VS with cardio-ankle vascular index (CAVI) assessment as part of the ESSE-RF study. During a 5-year follow-up, cardiovascular events (CVEs) (cardiovascular death, non-fatal myocardial infarction (MI) or stroke) were registered in 34 people. Individuals with high and very high CVR were identified according to traditional CVR stratification based on clinical, anamnestic, and carotid ultrasound data. Alternative options for CVR stratification using the criterion of increased AS (CAVI ≥8) were considered. The effectiveness of CVR stratification was assessed by identifying CVR over a 5-year follow-up period.

Results. Based on clinical, anamnestic and carotid ultrasound (plaques in 40% (n=386)) data, 605 (62%) individuals were classified as high and very high risk, accounting for 88% (30 out of 34) of CVEs over the follow-up period (CVE rate over 5 years — 5%). CAVI ≥8 was detected in 45% (n=432) of those examined. When using the CAVI ≥8 indicator instead of the plaque criterion, a group of 633 people was formed, which also accounted for 88% (30 out of 34) of the CVEs (CVE rate over follow-up period — 4,7%), i.e. the results are comparable with the traditional approach.

Conclusion. When stratifying the CVR in the Tomsk population sample, consideration of the criterion of increased AS (CAVI ≥8) in addition to clinical and anamnestic data forms a group of people with a comparable CVE rate over a 5-year follow-up period, as when taking into account the plaque criterion according to carotid ultrasound, which account for the same number (88%) of the CVEs. This suggests the use of VS with AS assessment in the CVR stratification.

Hypertension (HTN) remains one of the most pressing problems of modern healthcare. Morbidity and mortality associated with HTN continue to increase, despite a wide range of available antihypertensive agents and regular updates of related clinical guidelines. In October 2024, an annual forum was held to discuss the optimization of approaches to the treatment of HTN. During the discussion, special attention was paid to personalized therapy of patients, which should be based on modern concepts of the disease pathogenesis and individual risk factors. In addition, the validity of prescribing imidazoline receptor agonists, which are additional agents that lower blood pressure, in certain clinical situations was discussed, along with the main five classes of antihypertensive drugs. In routine practice, it is recommended to consider the use of centrally acting drugs, in particular moxonidine, to control hypertension as part of combination therapy. A central sympathetic inhibition with moxonidine therapy ensures control of blood pressure and has pleiotropic effects, among which the most important is an increase in tissue sensitivity to insulin. This is especially important for the treatment of hypertension in patients with obesity, metabolic syndrome, prediabetes, type 2 diabetes, in patients with various metabolic disorders (hyperglycemia, dyslipidemia, hyperuricemia) and in women in the peri- and postmenopausal period.

Over the past 50 years, the number of obese people has increased many times. Despite the excess weight, many patients may be metabolically healthy. But studies show that this condition is an intermediate stage ending with a metabolically unhealthy phenotype, which is associated with an increase in the incidence of cardiovascular events. The concept of metabolically unhealthy obesity is characterized by altered levels of various biomarkers, the significance of which in the context of predicting a metabolically unhealthy phenotype remains to be studied. The review is devoted to the analysis of modern research data on the role of hyperuricemia, gut microbiota and its metabolites, adipocytokines, as well as an assessment of their relationship with a metabolically unhealthy obesity.

Introduction. Diagnosis of silent coronary artery disease (CAD) in the early postoperative period is difficult. It is important to timely identify risk factors for cardiovascular complications before non-cardiac surgeries, which determines the optimal diagnostic and therapeutic strategy in the early postoperative period.

Brief description. In the presented case report, the results of examination, diagnostic and treatment tactics of a 59-year-old female patient with type 2 diabetes, hypertension and risk factors for CAD after hip arthroplasty without probable CAD are assessed. The physical examination of the patient was assessed using clinical, functional and laboratory methods, and following scales: Revised Cardiac Risk Index (RCRI); Myocardial Infarction or Cardiac Arest (Gupta MICA); Caprini risk score/Caprini Risk Assessment Model; The Wells criteria for pulmonary embolism; Heavy, Hypertensive, Atrial Fibrillation, Pulmonary Hypertension, Elder, Filling Pressure (H2FPEF). The risk of cardiovascular complications according to the RCRI and Gupta MICA scores was assessed as low. During non-cardiac surgery of moderate risk with blood loss, the patient developed acute cardiovascular failure. Troponin-positive myocardial infarction was diagnosed without electrocardiographic and echocardiographic signs of impaired local contractility, against the background of atherosclerotic coronary stenosis, confirmed by coronary angiography.

Conclusion. The case demonstrates the relevance of CAD probability assessment (pre-test, clinical) in patients with related risk factors during non-cardiac surgeries. According to Kashlan B, et al., the incidence of myocardial infarction after non-cardiac surgeries (2024) is 1%. Existing risk scores for periprocedural complications are not highly accurate and require meaningful application. The case is of interest to therapists, cardiologists, endocrinologists in relation to the preparation of a comorbid patient with CAD risk factors and the need to assess perioperative risks for an elective intervention with the achievement of recommended target indicators.

Introduction. Cancer occupies one of the leading positions in the list of the most common death causes in the world. The widespread use of chemo-, targeted, immune and radiation therapy in clinical practice has increased the survival of cancer patients. However, the incidence of cardiotoxic complications of antitumor therapy has increased significantly, and they may manifest themselves many years after the onset of cancer remission.

Brief description. We present a case of premature coronary artery disease (CAD) in a 40-year-old male patient, who underwent multiagent chemotherapy in combination with radiation therapy for mediastinal lymph nodes due to lymphogranulomatosis at the age of 22. In 2021, against the background of a stressful situation, the patient first noted a burning sensation in chest, which was relieved spontaneously, and an increase in blood pressure to 145/90 mm Hg. After visiting a cardiologist, a clinical, electrocardiographic and echocardiographic (at rest) examination was performed. However, no pathology was found, and therapy was not prescribed. Over the next 3 years, short-term squeezing pain in chest was periodically noted, occurring during fast walking, which was relieved when stopping. In April 2024, the patient was hospitalized in the cardiology department of the University Clinic of the N. A. Semashko Institute of Clinical Medicine of the Russian University of Medicine for an in-depth cardiological examination. Analysis of complaints and anamnestic data, clinical and paraclinical examination, made it possible to diagnose CAD, class III angina pectoris. This was regarded as a late manifestation of cardiotoxicity of chemotherapy in combination with radiation therapy to the mediastinal area, performed at the age of 22 for lymphogranulomatosis. Selective coronary angiography revealed multiple coronary stenoses. For myocardial revascularization, the patient was referred to the I. V. Davydovsky City Clinical Hospital, where 4 drug-eluting stents were inserted. Follow-up monitoring of the cardiovascular system was not carried out. When contacting a cardiologist with complaints typical for coronary insufficiency, CAD was not diagnosed.

Conclusion. The presented case shows the difficulties in diagnosing long-term manifestations of cardiotoxicity in the form of premature CAD. It is necessary to conduct additional educational activities and introduce modern technological products to improve the effectiveness of primary prevention, diagnosis and treatment of cardiotoxicity of antitumor therapy.

Constrictive pericarditis (CP) is a rare disease with various causes. At the end of the 20^th century, its etiology was often associated with tuberculosis, but recently the role of cardiac surgery has increased in developed countries. CP is difficult to diagnose due to the lack of specific manifestations. The disease is characterized by symptoms of systemic venous congestion due to impaired diastolic filling. In heart failure, pericardial calcification is often not detected on a chest X-ray, and the diagnosis is verified in clinical practice using Doppler echocardiography.

Case report. A 60-year-old man was hospitalized in November 2020 with complaints of progressive shortness of breath, swelling of lower limbs, anterior abdominal wall, lower back, and an increase in abdominal volume. In 2012, coronary artery bypass grafting was performed for multivessel coronary artery disease. Since 2018, the above complaints have appeared. Clinical manifestations were assessed as the development of heart failure due to ischemic cardiomyopathy. The prescribed complex therapy did not give an effect, and shortness of breath and edema and ascites continued to progress. It was necessary to find out the cause of the increase in systemic venous congestion. Taking into account the medical history and physical examination, pulmonary embolism, heart defects, pericarditis, as well as extracardiac pathology were included in the diagnostic search. The diagnosis of CP was established on the basis of the clinical performance, echocardiography and chest computed tomography. In April 2021, the patient underwent pericardiectomy. Subsequently, clinical and paraclinical improvement was noted with the disappearance of shortness of breath, edema, and an increase in myocardial contractility.

Conclusion. The rare occurrence of the disease, a long period without manifestations after cardiac surgery, non-specific symptoms and concomitant diseases led to a delayed diagnosis of CP. Its clinical feature is the complexity of diagnosis and the use of a single method of treatment (pericardiectomy), which improves the patient's prognosis.